Medicare Special Enrollment Periods Granted Due to Coronavirus (COVID-19) Outbreak
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If the novel coronavirus (COVID-19) outbreak impacted your ability to enroll in or make changes to your Medicare coverage, you may qualify for a Special Enrollment Period (SEP).
Two Special Enrollment Periods are being granted to qualified individuals who were unable to enroll in or make changes to coverage because of shutdowns related to the Coronavirus pandemic.
One Special Enrollment Period is for individuals looking to enroll in Original Medicare, which consists of Medicare Part A and/or Part B.
The second Special Enrollment Period is for those wanting to enroll in or make changes to Medicare Advantage, Medicare Part D or Medicare/Medicaid plans.
When are the Medicare special enrollment periods for COVID-19?
The Special Enrollment Period for those who are enrolling in Original Medicare is retroactive to March 17 and lasts until June 17.
The Special Enrollment Period for Medicare Advantage, Medicare Part D and Medicare/Medicaid plans is retroactive to March 1 and lasts until June 30.
Who is eligible for a Medicare special enrollment period?
In order to qualify for the Original Medicare Special Enrollment Period, you must have been in your Initial Enrollment Period (IEP), General Enrollment Period or another Special Enrollment Period between March 17 and June 17 and did not submit an enrollment request to the Social Security Administration.
In other words, if you were eligible to enroll in Medicare Part A or Part B for the first time at any point between March 17 and June 17 but did not do so, you may be eligible for this Special Enrollment Period.
In order to qualify for the Special Enrollment Period for Medicare Advantage, Medicare Part D and Medicare/Medicaid plans, you must have had a valid enrollment period between March 17 and June 30 and did not make any changes to your coverage at this time.
Valid enrollment periods include your IEP, another Special Enrollment Period or the Medicare Advantage Annual Enrollment Period that occurs each fall.
For either enrollment period, it is not required to show any proof that you failed to take enrollment action due to COVID-19. Qualification is based on the above criteria.
What can you do (and not do) during these Special Enrollment Periods?
If you qualify for the Special Enrollment Period to sign up for Original Medicare, you will be able to:
Sign up for Medicare Part A with no late enrollment penalty
Sign up for Medicare Part B with no late enrollment penalty
Refuse your Medicare Part B automatic enrollment
Here is what you can do during the Special Enrollment Period for Medicare Advantage, Medicare Part D and Medicare/Medicaid plans:
Switch from one Medicare Advantage plan to another, if you were already enrolled in a Medicare Advantage plan
Disenroll from a Medicare Advantage plan and revert back to Original Medicare with the option of also enrolling in a Medicare Part D plan (if the dropped Medicare Advantage plan contained prescription drug coverage).
Enroll in a Medicare Advantage plan or a Medicare Part D plan (if you were not already enrolled in Medicare and were in your Medicare IEP or another Special Enrollment Period between March 17 and June 30)
Here is what you may not do during these Special Enrollment Periods:
Switch from Original Medicare to Medicare Advantage or join a Medicare Part D plan if you were already enrolled in Original Medicare
Switch from one Medicare Part D plan to another, unless you were already qualified for a different Special Enrollment Period during this time and did not make any changes to your coverage at that time
Make any enrollment changes if you already took any previous actions during another enrollment period during this time
How can I take action and enroll or make changes to my coverage?
Here’s how to take advantage of these Special Enrollment Periods and enroll in or make changes to your coverage, if you qualify.
If enrolling in Medicare Part A for the first time, you may do one of the following:
Call to speak with an SSA representative by calling the toll-free number 1-800-772-1213.
If enrolling Medicare Part B, you may do one of the following:
Print off and complete form CMS-40B and form CMS-L564 and either mail or hand-deliver to your local Social Security office. You may also fax the forms to the Social Security Administration at 1-833-914-2016.
Enroll online on the official SSA website (those who are already enrolled in Part A may not sign up for Part B online).
For help with Part A and/or Part B enrollment, you may call 1-800-MEDICARE (1-800-633-4227). TTY users may call 1-877-486-2048.
If enrolling in or making changes to Medicare Advantage, Medicare Part D or a Medicare/Medicaid plan, you may do one of the following:
Contact your plan directly (if already enrolled in coverage).
Compare Medicare Advantage and Part D plans available near you online or speak to a licensed insurance agent about your options. Visit MedicareAdvantage.com to compare Medicare Advantage and Part D plans that may be available where you live.
When will my coverage take effect?
If you sign up for or make changes to your coverage during either of these Special Enrollment Periods, your coverage will be effective retroactive to the date that the coverage would have begun under the original enrollment period for which you were eligible.
What is a Special Enrollment Period?
There are several Medicare enrollment periods that happen at the same time of the year every single year. Then there are Special Enrollment Periods.
A Special Enrollment Period (SEP) is not a scheduled enrollment period. In other words, they may be granted at any time of the year due to certain circumstances. A Special Enrollment Period may be granted to just one individual or they may be granted to a large group of individuals, such as the case with the COVID-19 SEP.
Some of the circumstances that may warrant a Special Enrollment Period include:
Moving to a new address that causes you to live outside of your plan’s coverage area or for which additional coverage options become available
Moving back to the U.S. after living outside of the country
Moving into, out of or residing in a skilled nursing facility or long-term care hospital
Involuntarily losing drug coverage that is at least as good as Medicare’s (called “creditable coverage”)
In the case of COVID-19, the government is granting a Special Enrollment Period to all Medicare beneficiaries who were affected by the pandemic. These Special Enrollment Periods are sometimes granted during pandemics and weather disasters.
Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.